非外科处理的梗阻性黄疸:附五例病例分析  

Clinical analysis of five cases of obstructive jaundice in Ineffective surgical treatment

作　　者：林锐[1] 刘中砚[1] 王晖[1] 陈泉宁[1] 施宝民[1] LIN Rui;LIU Zhongyan;WANG Hui(Department of General Surgery HBP ward,Tongji Hospital,Tongji University,200065 Shanghai,China)

机构地区：[1]同济大学附属同济医院普外科肝胆胰病区

出　　处：《临床外科杂志》2019年第8期655-658,共4页Journal of Clinical Surgery

摘　　要：目的探讨非外科处理的梗阻性黄疸的诊断与治疗。方法分析5例非外科处理或外科处理无效的梗阻性黄疸病例的临床资料。结果5例梗阻性黄疸病人占我科同期收治梗阻性黄疸病例(532例)的0.9%,5例病人入院时碱性磷酸酶(ALP)平均值为(242.1±80.1)U/L,谷氨酰转肽酶(GGT)平均值为(520.5±259.4)U/L,总胆红素(TBIL)平均值为(216.1±97.9)μmol/L,结合胆红素平均值为(120.5±64.7)μmol/L,均符合胆汁淤积的诊断。其中,1例病人肝门部胆管癌合并肝内胆道淤积,左半肝切除胆肠吻合术后黄疸不退;1例胆总管结石合并肝内胆管梗阻做了胆道探查手术黄疸不退,其余3例病人经过药物治疗缓解。结论肝外胆道梗阻合并肝内胆汁淤积的病人外科手术效果不佳;肝内胆汁淤积引起的梗阻性黄疸首选非手术药物治疗,多学科治疗可能是一种适宜的诊疗模式。Objective To discuss the diagnose and therapy of obstructive jaundice which could not be managed by surgery.Methods Five inpatient case reports of obstructive jaundice that could not be managed or failure to be managed just by surgery in recent one year.Results These 5 patients(0.9%)had average ALP value of(242.1±80.1)U/L,GGT value of(520.5±259.4)U/L,TBIL value of(216.1±97.9)μmol/L,and DBIL value of(120.5±64.7)μmol/L,which can be diagnosed of cholestasis.Among these patients,one patient diagnosed of hepatic hilar carcinoma who received left hemi-hepatectomy and choledochojejunostomy still had cholestasis after surgery.One patient who received common biliary operation for choledochal lithiasis had cholestasis after operation.The other 3 patients are relief from cholestasis after medication therapy.Conclusion The surgeons should be cautious of this kind of patients with obstructive jaundice originated from both intra-and extra-hepatic biliary obstruction.Multidisciplinary therapy(MDT)is an appropriate pattern for the patients with no obvious evidence of obstruction in bile duct on image.

关 键 词：胆汁淤积性黄疸 非外科处理 临床分析 

分 类 号：R65[医药卫生—外科学]